Complications after surgery

My question is this....if my insurance denies me coverage and I go ahead with the reduction, if I encounter problems afterwards will my insurance company cover the costs involved with getting those problems resolved....ie infections that may lead to hospitalization so forth?

Doctor Answers 11

Health insurance and cosmetic surgery

August 2nd, 2014

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Everyone's health insurance policy is different, however, in general, most health insurance plans do not cover any complications resulting from a cosmetic procedure. You have to read the fine print of your individual plan. It doesn't hurt to try and bill health insurance since they do cover these issues sometimes. However, there are very reasonable priced cosmetic insurance plans that can be purchased prior to your cosmetic procedure that cover complications resulting from the cosmetic procedure. Your plastic surgeon can give you information on these plans that are sold by a separate company. You can also ask your plastic surgeon if you are at increased risk of having a complication and thus worth the extra expense of obtaining the policy. Best wishes,Pablo Prichard, MD

Complications after surgery

December 13th, 2011

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I cannot answer this question with any certainty as this deals with the contract between you and your insurance company. I agree that if your agent says they would cover a complication please get that answer in writing!

Yes, the chances that you would have a complication requiring hospitalization are low, but if you are the one with the complication, then for you the rate was 100%. Do all that you can to avoid complications by following your surgeons pre- and post-operative instructions carefully.

On another note, my cosmetic patients are covered through CosmetAssure. Unfortunately not all states allow this option.

Insurance Coverage for Noncovered Breast Reduction

December 13th, 2011

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This is a tricky issue and you need to read the fine print in your insurance plan. While your breast reduction may not be cosmetic, the insurance company may feel differently. You should be prepared to deal with whatever complications arise using your own funds. Be sure to discuss your concerns with your plastic surgeon.

Breast Reduction Pictures

Insurance coverage for cosmetic surgery complications

December 12th, 2011

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Some insurance companies are very clever in their contacts, and may exclude complications from cosmetic surgery. Breast implants particularly come up as restricted in policies. The best way to know is to contact the consumer line of your insurance carrier and ask questions, and ask for confirmation in writing.

Complications after Breast Reduction and Insurance Coverage?

December 12th, 2011

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Thank you for the question.

Every insurance company will have a different policy in regards to coverage of complications after “noncovered procedures”. Therefore, for the most precise answer you will have to check with your insurance company.

Fortunately, the incidence of serious complications after breast reduction surgery requiring hospitalization or emergency room visits is very small. Breast reduction surgery tends to be one of the most patient pleasing operations performed.

Breast Reduction Complications and Insurance Coverage

December 12th, 2011

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Dear TallOne, Each insurance policy has its on limits on what is covered and what is not covered. This is why a large company can sometimes cover a procedure or a complication of a procedure and in another one of the policies it issued, those very same areas are not covered. The only way to know is to read your own individual policy.

Many insurance carriers will not cover the costs associated with complications of a procedure that they did not originally cover. Therefore, if you had a complication from an elective breast reduction, your costs may not be covered by your insurance carrier. This is why many plastic surgeons offer to their patients insurance policies to cover the complications that may arise from a cosmetic procedure. Please ask your plastic surgeon if they have such a policy and ask to read the coverage benefits before proceeding.

The good news for most patients undergoing a breast reduction procedure is that there complication rate is very low and usually these can be managed outside the hospital with little to no costs to the patient.

The answer to your question should be directed to an insurance with your insurance company. If the answer is yes, you probably want to have this in writing. With that said, the risk that you would require hospitalization for a breast reduction complication is extremely low. Most issues are minor in nature and can be addressed in an office visit.

In my experience, if you have a complication directly related to the surgical procedure such as an infection or bleeding that requires surgical care or hospitalization, insurance will cover these problems. If you have, on the other hand, cosmetic issues with the scar or shape of the breasts then coverage is much less likely.

Insurance coverage after complicated cosmetic surgery

December 12th, 2011

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Most complications can be taken care of with minimal cost. For extremely complex problems your insurance plan may or may not offer coverage, though for emergencies the insurance company is usually in the hook. Read you plan and all the fine print: there may be some guidance there.

These answers are for educational purposes and should not be relied upon as
a substitute for medical advice you may receive from your physician. If you
have a medical emergency, please call 911. These answers do not constitute
or initiate a patient/doctor relationship.